Initial intraosseous access shows no survival benefit over intravenous access in out-of-hospital cardiac arrest

This randomized clinical trial evaluated the efficacy of initial intraosseous vascular access compared with initial intravenous vascular access in adults with non-traumatic out-of-hospital cardiac arrest. The study population consisted of 1479 patients. The setting was not reported. The primary outcome was survival. Follow-up assessments occurred at 6 months and 1 year. Three patients were lost to follow-up for 1-year survival. No adverse events, serious adverse events, discontinuations, or tolerability data were reported.

At 1 year, 82 patients (11%) in the intraosseous group and 68 patients (9%) in the intravenous group were alive. The effect size was a risk ratio of 1.24. The 95% confidence interval was 0.91-1.67. The p-value was not reported. For survival with a favourable neurological outcome at 1 year, 76 patients (10%) in the intraosseous group and 61 patients (8%) in the intravenous group achieved this result. The effect size was a risk ratio of 1.28. The 95% confidence interval was 0.93-1.77. The p-value was not reported.

Health-related quality-of-life among survivors was assessed using the EQ-5D-5L instrument. The mean EQ-5D-5L numeric score was 83 in the intraosseous group and 76 in the intravenous group. The mean difference was 7. The 95% confidence interval was 1-13. The p-value was not reported. Safety and tolerability findings were not reported.

The main results indicate that initial intraosseous vascular access does not improve survival compared with initial intravenous vascular access. The absolute numbers were 82/1479 versus 68/1479 for survival at 1 year. The confidence intervals for the primary and secondary outcomes included the null value, indicating no statistically significant difference. The study design was a randomized clinical trial. The sample size was 1479. The conditions were out-of-hospital cardiac arrest. The comparator was initial intravenous vascular access.

These results suggest that clinicians should not prefer intraosseous access over intravenous access based on survival outcomes alone. The findings do not support a difference in patient outcomes between the two vascular access strategies. The lack of reported safety data limits the ability to assess tolerability differences. The loss of three patients to follow-up for 1-year survival is a methodological limitation that may affect the precision of the long-term estimates.

No prior landmark studies were explicitly compared in the provided text. The certainty of the evidence is not reported. Funding or conflicts of interest were not reported. The practice relevance is that the choice between these access methods may depend on other factors not captured by this trial. Questions remain regarding the optimal timing of access and the impact of specific procedural techniques on long-term quality of life.